PERCUTANEOUS TRANS-HEPATIC PORTOGRAPHY IN THE ASSESSMENT OF PORTAL-HYPERTENSION - CLINICAL CORRELATIONS AND COMPARISON OF RADIOGRAPHIC TECHNIQUES

Abstract

Transhepatic portograms [64] performed before transhepatic obliteration of varices in patients with variceal hemorrhage were reviewed. Patients [62] had coronary gastroesophageal vessels feeding gastric and esophageal varices and other major collateral circulation was seen in 25 patients. There was no relationship between the presence of major collateral circulation and the height of portal pressure or the severity of hemorrhage from gastroesophageal varices. Failure to opacify the intrahepatic portal venous system was seen in 11 patients and was strongly associated with portal-sytemic encephalopathy. In addition to transhepatic portography, 35 patients had a splenic portogram, and 27 patients had celiac axis angiography. There was poor agreement between the findings of these 3 techniques. Transhepatic portography was markedly superior in demonstrating the portal-systemic collateral circulation. Because of the excellent anatomical definition obtained, transhepatic portography is a superior technique for visualizing the portal system. Even this technique may occasionally fail to demonstrate gastroesophageal collateral circulation in patients with endoscopically documented variceal hemorrhage.